Exercise Induced Bronchoconstriction
Key Points
Key Points
- The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
- Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
- The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
- The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
- EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
- Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.
Diagnosis
...Diagnosis
...ement (SS)1: In asthmatic patients EI...
...diagnosis of EIB should be confirmed by d...
...aluate EIB in elite athletes by usi...
...Perform a standardized bronchoprovocation...
...subjects with no current clinical hist...
...e an indirect graded challenge (eg, man...
...an indirect challenge (eg, exercise challe...
...: Ensure the ventilation reached and...
...as the preferred surrogate challenge f...
...ndirect graded challenge (eg, mann...
...: To differentiate between EIB and exerc...
...: To determine whether exercise-induced dyspnea...
...13: Perform spirometry, as well as detai...
...nsider a diagnosis of exercise-induced anaphylax...
Treatment
...Treatmen...
...o appropriate specialists (eg, cardiologist or p...
...patients for psychological evaluati...
...le regular office visits with patients beca...
...β2-...
...rescribe inhaled short-acting β2-...
...rescribe a single dose of SABA, LABA...
...cautious in daily use of β2-adrenergic agent...
...Leukotriene Inhibit...
...S21: Consider prescribing daily therapy with leuko...
...Mast C...
...r prescribing inhaled cromolyn sod...
...rescribing ICSs in combination with other therapi...
...24: Do NOT prescribe daily LABAs with IC...
...Anticholinerg...
...5: Consider prescribing inhaled ipratropium...
...Nonph...
...S26: Prescribe pre-exercise warm-up for...
...onsider with caution the recommendation...
...Com...
...: Treat athletes with EIB alone in a...
...gure 1. Algorithm for the Diagnosis, Treatmen...